10/1/2023 EnchantaVaughn Approved Behavior: Client presented for today’s session as both moody and sad. Client continues to be defiant, disrespectful, and impulsive. Client had difficulty focusing in the session, due to these behaviors. Client struggled with following directions and being respectful during session. Client discussed things she would like to do over what the QMHP instructed her to do. Client had difficulty concentrating in session. Client was not acceptive of redirection and responded aggressively by saying “I don’t want to talk to you anymore”. Behavior: Client did not demonstrate a cooperative attitude during family activity. Client was provided with feedback about how her behavior and verbal messages have an impact on others. Client expressed negative “I statements” (e.g. "I hate staying in this boring house"). Client was encouraged to think positive and reminded to relax when she feels overwhelmed. Client was receptive to the encouraged as seen calming down and being more cooperative in the session. After about 2-3 prompts, client returned to normal behavior. Intervention: QMHP inquired of client’s current mood. QMHP utilized active listening skills as client spoke of her current mood. QMHP assisted client to behave in more positive ways by addressing the conflict she was facing with her mom. QMHP informed client of replacement behaviors in efforts to decrease attention seeking behaviors the client is often involved in. QMHP will teach client necessary coping skills to decrease impulses significantly. QMHP will review key concepts of being the responsible and oldest child in the home. Intervention: QMHP engaged the client in a role reversal exercise and required the client to think about her goals. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue the positive behaviors she was exhibiting. QMHP modeled pro-social behaviors for client to strengthen her understanding of them. QMHP commended client on utilizing coping strategies to increase her understanding of feelings and emotions. Response: It was communicated by parent that client needs to realize that she has a lot going for herself and that could all be taken away with one small mistake. Client often allows others to get her off track. Client was able to deescalate behaviors once given new directions, but only minimally participated as she continued to be guarded and distant. Client is aware that she can be stubborn. Client admitted that she can’t control her temper sometimes. Client reported that she is looking forward to receiving the help she needs. Response: Client acknowledged she wants to learn how to deal with her anger and depression in a more stable way. Client understands that her treatment plan is a behavior contract that will reflect her improvements in the home. Client stated that she is open to new interventions. Client was acceptive of prompts given by mom and counselor. Client agreed to listen to the adult and follow all rules no matter if she sees someone else breaking them. Client ended session on a positive note.